Search

Background and Objective: Alteplase, a recombinant tissue-type plasminogen activator (rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke (AIS). Tenecteplase is a modified rtPA, which is cheaper. We aimed to study influence of socioeconomic status (SES) in patients' preference of thrombolytic agent and its outcome., Methods: This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolyzed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen, and outcomes like National Institutes of Health Stroke Scale (NIHSS) scores at 24-h and at discharge; and modified Rankin Scale (mRS) after 3 months., Results: Thirty-nine patients received tenecteplase and 39 patients received alteplase. Seven patients belonged to upper class, all of whom (100%) chose alteplase. Thirty patients belonged to upper middle class, of whom 25 (83.3%) and five (16.7%) patients chose alteplase and tenecteplase, respectively. Twenty-five patients belonged to lower middle class in which seven (28%) and 15 (72%) chose alteplase and Tenecteplase, respectively. Twenty patients were in upper lower class, of whom 4 (20%) and 16 (80%) chose alteplase and Tenecteplase, respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant (P = 0.000). Median 3 month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups, respectively (P = 0.608). There were no significant differences in NIHSS score improvement at 24 h postthrombolysis (P = 0.537) or at discharge (P = 0.429) among different SES categories. No correlation between SES and 3 month-mRS score was found (Spearman's ρ = 0.101, P = 0.398)., Conclusions: Majority of patients in upper and lower SES chose alteplase and Tenecteplase, respectively. However, there were no significant differences in outcomes among various SES categories., (Copyright © 2024 Copyright: © 2024 Neurology India, Neurological Society of India.)

Purpose: The association between exposure to Toxocara canis and epilepsy is at the best contentious. Most of previous studies were retrospective, community-based, and contradictory to one another. As the impact of a positive association on the magnitude of epilepsy will be huge especially in developing countries where toxocariasis is common owing to poor hygienic practices, this study was carried out to determine whether exposure to T. canis predisposes to development of epilepsy., Patients and Methods: This case-controlled observational study was carried out a tertiary healthcare center in North India on 120 patients with newly diagnosed epilepsy who presented within 3 months of diagnosis. A total of 120 age- and sex-matched individuals from the same community were chosen as controls. Epilepsy was defined according to ILAE 1993 definition. Serological testing for T. canis was carried out using commercially available ELISA kits. All the positive samples were subjected to Western blot testing for confirmation., Results: The prevalence of antibodies to T. canis was similar in cases (16/120; 13.3%) and controls (16/120; 13.3%). Among the various risk factors, history of pica was significantly associated with T. canis seropositivity, while lack of hand washing was significantly associated with higher risk of epilepsy., Conclusion: Our study could not find any association between exposure to T. canis and epilepsy., Competing Interests: None

Introduction: To understand neuromyelitis optica spectrum disorders (NMOSDs) better we need to study them in different populations. This prospective study was conducted to characterize clinical, serological, radiological, and therapeutic profile of NMOSDs in a North Indian population., Materials and Methods: This study included 81 patients with NMOSDs. All patients underwent detailed history and examinations and were followed at 3 monthly intervals. They were evaluated using standard investigations including gadolinium-enhanced magnetic resonance imaging (MRI) of the brain and spine with thin section optic nerve cuts and treated as per the standard guidelines. Data were recorded meticulously., Results: The mean age was 33.7 ± 13.4 years. The mean age at disease onset was 31.2 ± 13.5 years. Female-to-male ratio was 1.9:1. About 32.1% of patients presented with optic neuritis (ON), 56.8% with transverse myelitis (TM), and 11.1% with both ON and TM. The mean time from disease onset to diagnosis was 16.17 ± 23.09 months. Muscle atrophy, Lhermitte symptom, and tonic spasms were common. Foster-Kennedy syndrome-like presentation was seen in 8.6%. NMO antibodies were positive in 41 patients. MRI revealed involvement of <4 vertebral segments in 16.4% of patients with TM. Patients were managed as per standard guidelines. The mean follow-up duration was 15.3 ± 6 months. Approximately 88.9% had good functional outcome., Conclusion: NMOSDs are a common cause of demyelinating illnesses in Northern India. The response to treatment is excellent and most patients recover without residual disability., Competing Interests: None

Background and Purpose: Dengue can present with variable neurological complications including encephalitis, encephalopathy, acute disseminated encephalomyelitis (ADEM), and ischemic and hemorrhagic stroke. Our study describes a pattern-based approach to recognize different brain MRI findings in dengue-seropositive patients with neurological symptoms., Materials and Methods: Thirty-six serologically proven dengue patients with neurological symptoms and undergoing brain MRI over a 6-month period were included in this study. The diagnosis of dengue encephalopathy or encephalitis was established by presence of signs/symptoms of acute encephalitic syndrome with the presence of Immunoglobin M (IgM) antibody against dengue antibody in the serum and/or presence of dengue antigen (NS1) in serum. The MRI brain along with diffusion weighted imaging and susceptibility weighted imaging sequences were evaluated by an experienced neuroradiologist., Results: Eleven patients had normal MRI finding. In the rest 25 patients, 12 were found to have encephalitic pattern, 4 had encephalopathic (seizure related/metabolic) pattern, 3 had features of ADEM, and isolated micro- or macro-hemorrhages were found in 6 patients. In the encephalitis group, eight had concomitant involvement of brainstem, cerebellum, and ganglio-thalamic complexes with additional involvement of cortex and subcortical white matter (WM) found in three. Isolated brainstem and cerebellar involvement were seen in three in this group, whereas one had isolated cerebellar involvement. Interspersed hemorrhage was noted in the structures involved in eight patients in encephalitis group., Conclusion: Radiologists should be aware of various MRI brain findings in dengue and a pattern recognition approach often helps in reaching the correct diagnosis albeit after exclusion of other differentials based on laboratory studies., Competing Interests: None

It has been approximately five decades since Dastur et al., published their seminal work on pathology of tuberculous meningitis (TBM). Though most of their findings find relevance in today's era, there is an important difference; these findings can now be replicated during life using modern day technology. In this article, we review the seminal words of Professor Dastur and colleagues, analyse their findings, interpret how these revolutionized our understanding of TBM and highlight their relevance in today's era. We also discuss challenges in the management of TBM, which we continue to face today and the various options required to overcome these challenges., Competing Interests: Authors declare that they do not have any conflict of interest. They do not have any source of funding

Competing Interests: There are no conflicts of interest

Competing Interests: There are no conflicts of interest

History helps us to become better students, judge wisely, understand change, and most importantly, it tells us who we are. It helps us to understand what happened, why it happened and what its ramifications are. Winston Churchill once said: "Study history, study history. In history lie all the secrets of statecraft." Here, we take this opportunity to pay our gratitude to our esteemed teachers who worked relentlessly for uplifting of the department of Neurology, PGIMER, Chandigarh; and, narrate chronicles of all those people who made this department reach the heights where it stands today.